Terminal remission is possible in some patients with juvenile myoclonic epilepsy without therapy/Terminalna remisija bez terapije moguca je kod bolesnika sa juvenilnom mioklonicnom epilepsijom

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Authors: Nebojsa J. Jovic, Ana Kosac and Milos D. Babic
Date: Nov. 1, 2014
From: Medicinski Pregled(Vol. 67, Issue 11-12)
Publisher: Drustvo Lekara Vojvodine
Document Type: Report
Length: 5,215 words
Abstract :

Introduction. Juvenile myoclonic epilepsy is considered to be a chronic disease requiring lifelong antiepileptic treatment. The aim of this study was both to identify factors predicting the kind of seizure control and to investigate the outcome in patients after therapy withdrawal. Material and Methods. The study included 87 patients (49 female, 38 male), aged from 17.5 to 43.5 years, referred to our Department between 1987 and 2008, with the seizure onset at the age of 14.3 [+ or -] 2.9, and followed up for 13.3 [+ or -] 5.8 years on average (from 5 to 23 years). Results. Sixty seven (77.0%) patients were fully controlled; whereas 13.8% had persistent seizures and 9.2% showed pseudoresistance. The combination of three seizure types and focal electroencephalogram features were independent factors of poor seizure control. Therapy was discontinued in 34 patients either by the treating physician (in 21 patients) or by the patients themselves (in 13 cases). In 18 subjects, all seizure types relapsed after 1.1 year on average (from 7 days to 4 years) and therapy was resumed in them. All patients but three (10/13), who stopped the treatment themselves, experienced recurrences. Seizure freedom off drugs was recorded in 10.3% patients. Nonintrusive myoclonic seizures recurred in 0.5-3 years as their only seizure type in four patients, but without reintroducing medication in three patients. Conclusion Combination of seizure types and focal electroencephalogram features are significant factors of pharmacoresistancy. Continuous pharmacotherapy is required in majority of patients, although about 10% of them appear to have permanent remission without therapy in adolescence. Key words: Myoclonic Epilepsy, Juvenile; Treatment Outcome; Anticonvulsants; Seizures; Drug Therapy; Recurrence; Drug Resistance; Risk Factors; Electroencephalography Uvod. Juvenilna mioklonicna epilepsija smatra se hronicnim stanjem koje zahteva dozivotnu primenu antiepileptickih lekova. Cilj ovog istrazivanja bio je da utvrdi cinioce predikcije vrste kontrole napada i da istrazi ishod posle obustave terapije kod ovih bolesnika. Materijal i metode. Sacinjena je grupa od 87 bolesnika (49 zenskog, 38 muskog pola), upucenih na nasu Kliniku u periodu 1987-2008. godine, starosti 17,5-43,5 godina, sa prosecnim pocetkom napada u zivotnom dobu od 14,3 [+ or -] 2,9 godina i pracenih u proseku 13,3 [+ or -] 5,8 godina (u rasponu 5-23 godine). Rezultati. Potpuna kontrola napada postignuta je kod 77% bolesnika, dok su se kod 13,8% napadi i dalje javljali a kod 9,2% postojala je pseudorezistencija. Pojava tri tipa napada i zarisne elektroencefalografske promene su nezavisni prediktivni faktori lose kontrole napada. Terapija je obustavljena kod 34 bolesnika: na predlog terapeuta kod 21 i po sopstvenoj odluci 13 bolesnika je samo obustavilo terapiju. Kod 18 ispitanika doslo je do recidiva svih tipova napada posle prosecnog perioda od 1,1 godine (raspon 7 dana do 4 godine) pa je terapija ponovo uvedena. Vecina (10/13) je imala recidiv napada posle samoinicijativne obustave terapije. Potpuna remisija napada bez terapije zabelezena je kod 10,3% bolesnika. Blagi mioklonicni napadi javili su posle 0,5-3 godina kao jedini tip napada kod 4 osobe, bez ponovnog uvodenja leka. Zakljucak. Vise tipova napada i zarisne elektroencefalografske promene znacajni su cinioci farmakorezistencije. Stalna primena lekova neophodna je kod vecine bolesnika sa juvenilnom mioklonicnom epilepsijom, iako oko 10% postize u adolescenciji dugotrajnu remisiju bez hronicne terapije. Kljucne reci: Juvenilna mioklonicna epilepsija; Ishod lecenja; Antiepileptici; Epilepticni napadi; Terapija; Rekurenca; Rezistencija lekova; Faktori rizika; Elektroencefalografija

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Source Citation
Jovic, Nebojsa J., et al. "Terminal remission is possible in some patients with juvenile myoclonic epilepsy without therapy/Terminalna remisija bez terapije moguca je kod bolesnika sa juvenilnom mioklonicnom epilepsijom." Medicinski Pregled, vol. 67, no. 11-12, 2014, p. 372+. Gale Academic Onefile, Accessed 21 Jan. 2020.
  

Gale Document Number: GALE|A395461967